We Need Better Skills for Better Outcomes
We Need Better Skills for Better Outcomes
Birkmeyer JD, Finks JF, O'Reilly A, et al; Michigan Bariatric Surgery Collaborative
N Engl J Med. 2013;369:1434-1442
To what extent does surgical skill determine outcome after a nontrivial surgical procedure? The authors examined this issue in a group of 20 bariatric surgeons whose skills were assessed independently by another group of surgeons who reviewed a videotape taken during the performance of a laparoscopic gastric bypass operation. On the basis of gentleness, exposure, instrument handling, time and motion, and operative flow, surgeons were divided into quartiles of surgical skill. Complication rates differed by surgical skill level, with the complication rate being 14.5% in the surgical group with the lowest skill rating and 5.2% in the group with the highest skill rating.
Surgical skill is an example of the "elephant in the room" metaphor. Despite being such an obvious determinant of outcome, surgical skill has rarely been measured. In this report, in addition to increased complication rates, surgical skill was linked to mortality, surgical operative time, and readmission rate.
Although this study was based on only a single procedure, it is likely that surgical skill is related to outcomes for other technically challenging procedures. In addition to being a valuable assessment tool, operative videotapes could be used by a mentor to help surgeons improve their technical skills.
Abstract
Surgical Skill and Complication Rates After Bariatric Surgery
Birkmeyer JD, Finks JF, O'Reilly A, et al; Michigan Bariatric Surgery Collaborative
N Engl J Med. 2013;369:1434-1442
Summary
To what extent does surgical skill determine outcome after a nontrivial surgical procedure? The authors examined this issue in a group of 20 bariatric surgeons whose skills were assessed independently by another group of surgeons who reviewed a videotape taken during the performance of a laparoscopic gastric bypass operation. On the basis of gentleness, exposure, instrument handling, time and motion, and operative flow, surgeons were divided into quartiles of surgical skill. Complication rates differed by surgical skill level, with the complication rate being 14.5% in the surgical group with the lowest skill rating and 5.2% in the group with the highest skill rating.
Viewpoint
Surgical skill is an example of the "elephant in the room" metaphor. Despite being such an obvious determinant of outcome, surgical skill has rarely been measured. In this report, in addition to increased complication rates, surgical skill was linked to mortality, surgical operative time, and readmission rate.
Although this study was based on only a single procedure, it is likely that surgical skill is related to outcomes for other technically challenging procedures. In addition to being a valuable assessment tool, operative videotapes could be used by a mentor to help surgeons improve their technical skills.
Abstract
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